Scleritis

Treatment of scleritis in Russia

In ophthalmological practice, inflammatory diseases of the sclera represent a serious clinical problem that requires a differentiated approach to diagnosis and therapy. Given the multifactorial nature and diversity of clinical forms of the disease, increased attention is paid to solving the problem of scleritis in Russia, which is associated with the need to minimize the risks of complications and preserve the visual functions of patients.

Causes of Scleritis

In most cases, scleral inflammation is associated with systemic diseases such as rheumatoid arthritis, systemic lupus erythematosus, Wegener's granulomatosis, sarcoidosis, and other autoimmune pathologies. In these conditions, the immune system attacks the body's own tissues.

Other possible causes include:

•  Infectious diseases (bacterial, viral, fungal);
  
  
• Mechanical trauma to the eyeball and chemical burns;
  
  
•  Postoperative complications;
  
  
•  Chronic inflammatory processes;
  
  
• Use of certain medications.
  
  

In some cases, the exact cause cannot be determined—such forms are classified as idiopathic

Classification

Scleritis is classified according to several criteria, which helps determine treatment tactics and disease prognosis.

By anatomical location:

•      Anterior scleritis – the most common form, affecting the outer layers of the sclera;
  
  
•      Posterior scleritis – a rare, more severe form involving the deeper structures of the eye.
  
  

By type of inflammation:

• Diffuse scleritis – involves a significant portion of the sclera and may lead to persistent changes in scleral tissue;
  
  
• Nodular scleritis – characterized by the formation of dense, painful nodules;
  
  
• Necrotizing scleritis – the most severe form, leading to scleral tissue destruction.

Clinical Manifestations

The clinical picture varies depending on the form of the disease, its location, and the severity of the inflammatory process.

External Symptoms

Scleritis is accompanied by significant changes in eye tissues. The main external signs include:

• Redness of the sclera;
  
  
• Eyelid swelling;
  
  
•  Pronounced vascular pattern;
  
  
• Increased sensitivity to light (photophobia);
  
  
• Excessive tearing;
  
  
• Foreign body sensation.
  
  

The disease can present as either chronic or acute. Acute scleritis is characterized by the rapid onset of symptoms and their high intensity.

Anterior Scleritis

Anterior scleritis manifests as intense pain that worsens with eye movement, localized or diffuse inflammation, and redness of the sclera. In the nodular form, painful nodules appear on its surface. In advanced cases, tissue thinning and necrosis can occur, increasing the risk of vision impairment.

Posterior Scleritis

This form is accompanied by moderate to severe pain radiating to the temple or forehead, optic disc swelling, and in severe cases, retinal detachment. Patients may experience decreased visual acuity, discomfort during eye movement, and exophthalmos (protrusion of the eyeball). Due to symptom similarities with other ophthalmic conditions, thorough examination is required.

Diagnosis of Scleritis

Diagnosis involves a comprehensive examination aimed at confirming the disease, determining its form, and identifying possible causes.

Diagnostic Procedures

•  Slit-lamp examination – detects redness, nodules, swelling, and necrosis;
  
  
•  Ophthalmoscopy – assesses the condition of the fundus and posterior segment of the eye;
  
  
• Tonometry – rules out secondary glaucoma;
  
  
•  Ultrasound (US) of the eye – helps detect scleral thickening and fluid accumulation;
  
  
• CT or MRI – used in cases of suspected orbital structure involvement;
  
  
• Laboratory tests – identify infectious or autoimmune causes, as well as systemic diseases that may have triggered scleral inflammation.
  
  

Differential Diagnosis

Symptoms may resemble other ophthalmic conditions, so an accurate differential diagnosis is essential. The doctor must rule out episcleritis, uveitis, keratitis, and orbital cellulitis, which can present with similar clinical features.

Treatment strategies depend on the severity and underlying cause of scleritis. The combination of systemic therapy and local treatment helps reduce inflammation and prevent complications.